Healthcare Provider Details

I. General information

NPI: 1023932662
Provider Name (Legal Business Name): SAMAAN JUKAKU MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W THIRTEEN MILE RD COREWELL HEALTH WILLIAM BEAUMON
ROYAL OAK MI
48073
US

IV. Provider business mailing address

4/398A, JOSEPH ROAD, BEACH POST OFFICE
KOZHIKODE KERALA
673032
IN

V. Phone/Fax

Practice location:
  • Phone: 248-898-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351056908
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: